Healthcare Provider Details

I. General information

NPI: 1336942846
Provider Name (Legal Business Name): MARYLINE WEYGANG NKWANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 DODSON CT
BOWIE MD
20721-3232
US

IV. Provider business mailing address

1005 DODSON CT
BOWIE MD
20721-3232
US

V. Phone/Fax

Practice location:
  • Phone: 240-733-1626
  • Fax:
Mailing address:
  • Phone: 240-733-1626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: